Effect of Splenectomy on Risk of Infection and Hematological Complications among Sickle Cell Disease patients in Al-Ahsa Area - A retrospective cohort study
Sickle cell Disease (SCD) is one of the common inherited hemoglobinopathies in Saudi Arabia and a number of SCD patients undergo surgical splenectomy to prevent episodes of SCD crisis. This study was conducted to review the effect of this procedure on infectious and hematological complications.
Methodology
A retrospective cohort study was conducted among sickle cell disease patients registered in Al-Ahsa area hospitals at end of 1424 H, with an outcome assessment period of one year i.e. year 1425 H. Most of the data about demographic characteristics of patients, exposure status and outcome events was extracted from the hospital record; and supplemented by interviewing patients or their parents on telephone.
Results
A total of 113 SCD patients with surgical splenectomy were recruited in study as exposed group and another 311 SCD patients without splenectomy were recruited as unexposed group. Among the splenectomized patients, 47.8 % had at least one hematological during the period of follow-up as compared to 88.7% among non-splenectomized cases (OR = 0.12, 95% CI 0.070 - 0.193). While considering only for infectious events, 7.1% had at least one infectious event during the period of follow-up as compared to 21.5% among non-splenectomized cases (OR = 0.28, 95%CI 0.129 - 0.59). Lower risk was found statistically significant even after controlling for a number of demographic and disease related factors, using multivariate logistic regression. While comparing individual category of events it was found that statistically significantly lower risk was observed among splenectomized patients for septicemia, aplastic crisis, hemolytic crisis, acute sequestration crisis, painful crisis, vaso-occlusive crisis and bone crisis. Risk of CNS crisis was significantly higher among the splenectomized as compared to non-splenectomized. There was also significant lower number of hospital admissions and blood transfusions among splenectomized patients.
Conclusion
Splenectomy was beneficial in lowering the episodes of infectious and hematological events, while it also decreased the requirement for blood transfusion and admission to the hospitals due to SCD.